Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?
Background Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromisin...
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| Veröffentlicht in: | Annals of surgical oncology 2012-09, Vol.19 (9), p.3050-3056 |
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| creator | Huismans, Anna M. Kroon, Hidde M. Haydu, Lauren E. Kam, Peter C. A. Thompson, John F. |
| description | Background
Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromising outcome. The current study analyzed this proposed dose adjustment.
Methods
We reviewed 99 consecutive patients with lower extremity melanomas treated by ILI at our institution between May 1998 and February 2009. Toxicity and outcomes were tested for correlation with differences between administered dose and calculated adjusted dose, both in mg and mg/L, and with differences between actual limb volume and calculated adjusted limb volume.
Results
The median actual body weight was 71 kg, whereas the calculated median IBW was 57 kg (
p
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| doi_str_mv | 10.1245/s10434-012-2316-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1038759189</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2756313431</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-792cedd5a6d1f9ab2dadea3d39b4837f4f77e0594394bfbf927ecdc6940a582e3</originalsourceid><addsrcrecordid>eNp1kD1PwzAURS0EoqXwA1iQJeaAP5N4QqV8RSpioWKMnNhuUyV2sZOh_x5XAcTC9Kzn8-6VDgCXGN1gwvhtwIhRliBMEkJxmrAjMMU8blia4-P4RmmeCJLyCTgLYYsQzijip2BCCCdpLvIp2BYBvup2t5GttPDBBQ3najuEvtO2h_O6dl41dg17BwulZQvvndrDD92sNz1cBW2GFjYWFsG1stcKLpuugoU1Q2ichcb5Q7q0rpN35-DEyDboi-85A6unx_fFS7J8ey4W82VS04z0SSZIrZXiMlXYCFkRJWMxVVRULKeZYSbLNOKCUcEqUxlBMl2rOhUMSZ4TTWfgeszdefc56NCXWzd4GytLjGiecYFzESk8UrV3IXhtyp1vOun3ESoPdsvRbhntlge7JYs3V9_JQ9Vp9XvxozMCZARC_LJr7f9W_5f6BYIihRs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1038759189</pqid></control><display><type>article</type><title>Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Huismans, Anna M. ; Kroon, Hidde M. ; Haydu, Lauren E. ; Kam, Peter C. A. ; Thompson, John F.</creator><creatorcontrib>Huismans, Anna M. ; Kroon, Hidde M. ; Haydu, Lauren E. ; Kam, Peter C. A. ; Thompson, John F.</creatorcontrib><description>Background
Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromising outcome. The current study analyzed this proposed dose adjustment.
Methods
We reviewed 99 consecutive patients with lower extremity melanomas treated by ILI at our institution between May 1998 and February 2009. Toxicity and outcomes were tested for correlation with differences between administered dose and calculated adjusted dose, both in mg and mg/L, and with differences between actual limb volume and calculated adjusted limb volume.
Results
The median actual body weight was 71 kg, whereas the calculated median IBW was 57 kg (
p
< .001). Median administered melphalan dose was 7.7 mg/L. The median calculated adjusted dose was 6.5 mg/L (range 3.2–9.3 mg/L,
p
< .001). None of the three aforementioned parameters correlated with either Wieberdink toxicity grade or outcome. BMI did not correlate with toxicity either. Interestingly, a higher total melphalan dose did not only correlate with higher toxicity, but also with a lower response rate.
Conclusions
Adjusting the melphalan dose for IBW does not appear to reduce toxicity following ILI for melanoma. The effect on outcome remains uncertain. More research is needed to optimize melphalan concentrations in individual patients during ILI to limit toxicity without compromising the response.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-012-2316-4</identifier><identifier>PMID: 22526898</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Alkylating - administration & dosage ; Antineoplastic Agents, Alkylating - adverse effects ; Body Mass Index ; Body Weight ; Chemotherapy, Cancer, Regional Perfusion ; Female ; Humans ; Lower Extremity - anatomy & histology ; Male ; Medicine ; Medicine & Public Health ; Melanoma - drug therapy ; Melanomas ; Melphalan - administration & dosage ; Melphalan - adverse effects ; Middle Aged ; Oncology ; Organ Size ; Retrospective Studies ; Skin Neoplasms - drug therapy ; Surgery ; Surgical Oncology ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2012-09, Vol.19 (9), p.3050-3056</ispartof><rights>Society of Surgical Oncology 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-792cedd5a6d1f9ab2dadea3d39b4837f4f77e0594394bfbf927ecdc6940a582e3</citedby><cites>FETCH-LOGICAL-c372t-792cedd5a6d1f9ab2dadea3d39b4837f4f77e0594394bfbf927ecdc6940a582e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-012-2316-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-012-2316-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27911,27912,41475,42544,51306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22526898$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huismans, Anna M.</creatorcontrib><creatorcontrib>Kroon, Hidde M.</creatorcontrib><creatorcontrib>Haydu, Lauren E.</creatorcontrib><creatorcontrib>Kam, Peter C. A.</creatorcontrib><creatorcontrib>Thompson, John F.</creatorcontrib><title>Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromising outcome. The current study analyzed this proposed dose adjustment.
Methods
We reviewed 99 consecutive patients with lower extremity melanomas treated by ILI at our institution between May 1998 and February 2009. Toxicity and outcomes were tested for correlation with differences between administered dose and calculated adjusted dose, both in mg and mg/L, and with differences between actual limb volume and calculated adjusted limb volume.
Results
The median actual body weight was 71 kg, whereas the calculated median IBW was 57 kg (
p
< .001). Median administered melphalan dose was 7.7 mg/L. The median calculated adjusted dose was 6.5 mg/L (range 3.2–9.3 mg/L,
p
< .001). None of the three aforementioned parameters correlated with either Wieberdink toxicity grade or outcome. BMI did not correlate with toxicity either. Interestingly, a higher total melphalan dose did not only correlate with higher toxicity, but also with a lower response rate.
Conclusions
Adjusting the melphalan dose for IBW does not appear to reduce toxicity following ILI for melanoma. The effect on outcome remains uncertain. More research is needed to optimize melphalan concentrations in individual patients during ILI to limit toxicity without compromising the response.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents, Alkylating - administration & dosage</subject><subject>Antineoplastic Agents, Alkylating - adverse effects</subject><subject>Body Mass Index</subject><subject>Body Weight</subject><subject>Chemotherapy, Cancer, Regional Perfusion</subject><subject>Female</subject><subject>Humans</subject><subject>Lower Extremity - anatomy & histology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma - drug therapy</subject><subject>Melanomas</subject><subject>Melphalan - administration & dosage</subject><subject>Melphalan - adverse effects</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Organ Size</subject><subject>Retrospective Studies</subject><subject>Skin Neoplasms - drug therapy</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kD1PwzAURS0EoqXwA1iQJeaAP5N4QqV8RSpioWKMnNhuUyV2sZOh_x5XAcTC9Kzn8-6VDgCXGN1gwvhtwIhRliBMEkJxmrAjMMU8blia4-P4RmmeCJLyCTgLYYsQzijip2BCCCdpLvIp2BYBvup2t5GttPDBBQ3najuEvtO2h_O6dl41dg17BwulZQvvndrDD92sNz1cBW2GFjYWFsG1stcKLpuugoU1Q2ichcb5Q7q0rpN35-DEyDboi-85A6unx_fFS7J8ey4W82VS04z0SSZIrZXiMlXYCFkRJWMxVVRULKeZYSbLNOKCUcEqUxlBMl2rOhUMSZ4TTWfgeszdefc56NCXWzd4GytLjGiecYFzESk8UrV3IXhtyp1vOun3ESoPdsvRbhntlge7JYs3V9_JQ9Vp9XvxozMCZARC_LJr7f9W_5f6BYIihRs</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Huismans, Anna M.</creator><creator>Kroon, Hidde M.</creator><creator>Haydu, Lauren E.</creator><creator>Kam, Peter C. A.</creator><creator>Thompson, John F.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20120901</creationdate><title>Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?</title><author>Huismans, Anna M. ; Kroon, Hidde M. ; Haydu, Lauren E. ; Kam, Peter C. A. ; Thompson, John F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-792cedd5a6d1f9ab2dadea3d39b4837f4f77e0594394bfbf927ecdc6940a582e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents, Alkylating - administration & dosage</topic><topic>Antineoplastic Agents, Alkylating - adverse effects</topic><topic>Body Mass Index</topic><topic>Body Weight</topic><topic>Chemotherapy, Cancer, Regional Perfusion</topic><topic>Female</topic><topic>Humans</topic><topic>Lower Extremity - anatomy & histology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma - drug therapy</topic><topic>Melanomas</topic><topic>Melphalan - administration & dosage</topic><topic>Melphalan - adverse effects</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Organ Size</topic><topic>Retrospective Studies</topic><topic>Skin Neoplasms - drug therapy</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huismans, Anna M.</creatorcontrib><creatorcontrib>Kroon, Hidde M.</creatorcontrib><creatorcontrib>Haydu, Lauren E.</creatorcontrib><creatorcontrib>Kam, Peter C. A.</creatorcontrib><creatorcontrib>Thompson, John F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huismans, Anna M.</au><au>Kroon, Hidde M.</au><au>Haydu, Lauren E.</au><au>Kam, Peter C. A.</au><au>Thompson, John F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>19</volume><issue>9</issue><spage>3050</spage><epage>3056</epage><pages>3050-3056</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromising outcome. The current study analyzed this proposed dose adjustment.
Methods
We reviewed 99 consecutive patients with lower extremity melanomas treated by ILI at our institution between May 1998 and February 2009. Toxicity and outcomes were tested for correlation with differences between administered dose and calculated adjusted dose, both in mg and mg/L, and with differences between actual limb volume and calculated adjusted limb volume.
Results
The median actual body weight was 71 kg, whereas the calculated median IBW was 57 kg (
p
< .001). Median administered melphalan dose was 7.7 mg/L. The median calculated adjusted dose was 6.5 mg/L (range 3.2–9.3 mg/L,
p
< .001). None of the three aforementioned parameters correlated with either Wieberdink toxicity grade or outcome. BMI did not correlate with toxicity either. Interestingly, a higher total melphalan dose did not only correlate with higher toxicity, but also with a lower response rate.
Conclusions
Adjusting the melphalan dose for IBW does not appear to reduce toxicity following ILI for melanoma. The effect on outcome remains uncertain. More research is needed to optimize melphalan concentrations in individual patients during ILI to limit toxicity without compromising the response.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22526898</pmid><doi>10.1245/s10434-012-2316-4</doi><tpages>7</tpages></addata></record> |
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| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2012-09, Vol.19 (9), p.3050-3056 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Aged, 80 and over Antineoplastic Agents, Alkylating - administration & dosage Antineoplastic Agents, Alkylating - adverse effects Body Mass Index Body Weight Chemotherapy, Cancer, Regional Perfusion Female Humans Lower Extremity - anatomy & histology Male Medicine Medicine & Public Health Melanoma - drug therapy Melanomas Melphalan - administration & dosage Melphalan - adverse effects Middle Aged Oncology Organ Size Retrospective Studies Skin Neoplasms - drug therapy Surgery Surgical Oncology Treatment Outcome |
| title | Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma? |
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